Bariatric Surgery is Safe for Teens with Morbid Obesity

PHILADELPHIA — Bariatric surgery is safe and, in many cases, beneficial for teenagers with morbid obesity who would otherwise face a heightened risk of developing severe health problems, including heart disease and stroke, according to a new study from Penn Medicine and the Children’s Hospital of Philadelphia (CHOP). Researchers will present their findings on Sunday, October 27, at the American Academy of Pediatrics (AAP) 2019 National Conference & Exhibition in New Orleans.

“As the rate of childhood obesity continues to increase, it’s critical for us to identify whether weight loss procedures that are frequently performed on adults are also safe and effective options for adolescents and teens,” said the study’s senior author Robert A. Swendiman, MD, MPP, MSCE, a sixth-year general surgery resident at Penn Medicine. “One component of that evaluation is balancing the risks of weight loss surgery against the prolonged exposure to severe health risks associated with obesity. Our findings show that the risks of undergoing bariatric surgery are quite low, suggesting that—for the right patients—surgery can serve as a safe and effective way to improve the health of these pre-teen and teenagers.”

In the United States, there are nearly five million adolescents aged 10 to 17 with obesity, according to recent reports. Children with morbid or severe obesity—defined by a body mass index (BMI) at or above the 99^th percentile for children of the same age and sex—have a higher risk of developing serious health conditions, including type 2 diabetes, high blood pressure and high cholesterol.

Less than one percent of children with morbid obesity undergo surgical weight loss procedures each year. To examine whether BMI or age was associated with an increased likelihood of being readmitted to the hospital within 30 days of surgery, or experiencing postoperative complications, the Penn team used a validated national database to study the incidence, outcomes and trends of adolescent bariatric surgery. They reviewed more than 3,700 cases involving patients aged 10 to 19 who underwent minimally invasive (laparoscopic or robotic) Roux-en-Y gastric bypass or sleeve gastrectomy, which involves removing part of the stomach to make it smaller.  

Researchers found that the very few of the patients experienced complications (1.4 percent), readmissions (3.5 percent) or reoperations (1 percent). None of the patients died within 30 days of the surgery. They also observed a shift in the preferred surgical procedure, with the percentage of sleeve gastrectomy cases increasing from 74 percent in 2015 to 84 percent in 2017. Researchers attribute the shift, in part, to the higher rate of readmissions and complications experienced by patients who underwent Roux-en-Y gastric bypass, which involves creating a small pouch from the stomach and connecting it to the small intestine.

“We found no evidence that higher BMI was associated with an increased likelihood of poor health outcomes following adolescent bariatric surgery,” Swendiman said. “In fact, our findings suggest that more readily referring patients with lower BMIs for surgery, rather than delaying consideration of surgery until adolescents develop worsening obesity, may prevent patients from suffering the severe health conditions associated with long-term obesity.”

Gerard D. Hoeltzel, a research assistant at Penn and the first author, will present an abstract of the study from 8 a.m. to 9:15 a.m. on Oct. 27 at the Ernest N. Morial Convention Center, room 348-349.

Additional authors include Colleen Tewksbury, PhD, Matthew A. Goldshore, MD, PhD, Elizabeth Prout Parks, MD, Michael L. Nance, MD, and Kristoffel R. Dumon, MD.